Tool for lower colon surgery

ABSTRACT

A combination of an obturator designed to be apposed to the bowel and an external perineal tractor for assisting a surgeon during lower colon surgery. By fixing the relative axial positions of the obturator and tractor on a supporting pipe or rod, maximum &#39;&#39;&#39;&#39;stretch&#39;&#39;&#39;&#39; of the bowel is achieved and upward pressure can be applied on the perineum to assure the surgeon of an adequate length of bowel for anastomosis.

United States Patent [191' Lehmann l 51 Feb. 5, 1974 TOOL FOR LOWERCOLON SURGERY [76] Inventor: Arnold L. Lehmann, W. 49-34th Ave.,Spokane, Wash. 99201 [22] Filed: Aug. 19, 1971 21 Appl. No.: 173,012

3,071,137 1/1963 Niebel et al. 128/348 X 3,552,626 1/1971 Astafiev128/334 C 3,564,582 2/1971 Tjong-Joe-Wai 128/334 C FOREIGN PATENTS ORAPPLICATIONS 1,121,673 7/1968 Great Britain 128/334 R PrimaryExaminer-Channing L. Pace Attorney, Agent, or Firm-Wells, St. John &Roberts [5 7 ABSTRACT A combination of an obturator designed to beapposed to the bowel and an external perineal tractor for assisting asurgeon during lower colon surgery. By fixing the relative axialpositions of the obturator and tractor on a supporting pipe or rod,maximum stretch of the bowel is achieved and upward pressure can beapplied on the perineum to assure the surgeon of an adequate length ofbowel for anastomosis.

4 Claims, 10 Drawing Figures III/7f [56] References Cited UNITED STATESPATENTS 2,638,901 5/1953 Sugarbaker 128/334 C 3,048,177 8/1962 Takaro128/334 C 1,828,986 10/1931 Stevens 128/241 1,918,890 7/1933 Bacon128/334 C 3,040,748 6/1962 Klein et al 128/334 R TOOL FOR LOWER COLONSURGERY BACKGROUND OF THE INVENTION This invention is concerned withlower colon surgery, which must be accomplished within the restrictedconfines of the pelvis. In such operations, particularly when removinglesions in the lower bowel, the short length of the remaining bowelsometimes renders it impossible to successfully accomplish anastomosis.This results in an ultimate need for a colostomy. The combination ofobturators and tractors as described herein allows manipulation of thebowel to permit the surgeon to gain slightly more length in theremaining portion of the bowel upon which operative surgery is beingperformed.

SUMMARY OF THE INVENTION The invention comprises a surgical toolincluding a cylindrical obturator having one end smoothly rounded andhaving an annular groove permitting the bowel to be brought intoapposition to the obturator by application of a restrictive band aboutthe bowel exterior within the groove confines. The obturator is mountedcoaxially to a rigid elongated support member, and a radially protrudingtractor is mounted to the supporting member at a location spaced axiallyoutward from the obturator. This combination of an obturator and tractorenables the surgeon to move the obturator and tractor in unison to pushthe perineum inward and thereby improve internal access of the surgeonto the lower portions of the bowel.

It is the prime purpose of this invention to provide a tool to assist asurgeon during abdominal surgery on the lower bowel to gain added accessand control of the lower portions of the bowel during anastomosis.

Another object of the invention is to provide a flexible combination ofobturators and tractors suitable for lower colon surgery.

These and further objects will be evident from the following disclosure,taken together with the accompanying drawings, which illustrate severalembodiments of the basic structure.

DESCRIPTION OF THE DRAWINGS FIG. 1 is an axially-explodedcross-sectional view of a first embodiment of the invention, with aportion of the supportive pipe being broken away;

FIGS. 2-6 show the steps involved in use of the invention;

FIG. 2 is a longitudinal cross-sectional view through the bowel showinginitial placement of the obturator;

FIG. 3 is a longitudinal cross-sectional view through the bowel showingthe removal of the pipe;

FIG. 4 is a longitudinal cross-sectional view through the bowel showinginsertion of a second'obturator;

FIG. 5 is a partial longitudinal cross-sectional view through the bowelshowing use of a first perineal tractor;

FIG. 6 is a partial longitudinal cross-sectional view through the bowelshowing use of an alternate obturator and perineal tractors;

FIG. 7 is an axially-exploded cross-sectional view showing a firstobturator and perineal tractor combination;

FIG. 8 is an end view of the assembled perineal tractor shown in FIG. 7;

FIG. 9 is an axially-exploded cross-sectional view of the alternateobturator and perineal tractor; and

FIG. 10 is an end view of the perineal tractor shown in FIG. 9.

DESCRIPTION OF THE PREFERRED EMBODIMENTS The drawings illustrate severalforms of luminal obturators, which are used in combination withsupportive pipes or rods and perineal tractors. These elements aredesigned for use by a surgeon during operations on the lower bowel andby a technical assistant assisting in the perineal area during suchoperations. While specifically designed to assist in lower colon surgeryto remove cancerous sections, the apparatus has further application incleansing and surgical procedures relating to the lower bowel.

The drawings illustrate three forms of the obturator and twoillustrative perineal tractors used in combination with them. Acleansing obturator 10 is shown in various operative positions in FIGS.1-4. A holding obturator 20 is illustrated in FIGS. 4-7. An intermediateor connecting obturator 30 is illustrated in FIGS. 6 and 9. Oneillustrative perineal tractor is shown in FIGS. 5, 7 and 8. A secondform of tractor is shown in FIGS. 6, 9 and 10.

The cleansing obturator 10 is preferably made of plastic resin such asTeflon" brand polytetrafluorethylene. These materials are particularlywell suited because they slip well and are resistant to heat. Metallicmaterials are suggested for the connecting obturator 30 to provideincrease strength.

The cleansing obturator 10 is basically cylindrical in shape, having afirst axial end 11 smoothly rounded to facilitate its insertion withinthe bowel. In FIGS. 2-6, the lower section of the bowel is generallyshown at 8 and the surrounding perineum is designated at 9. Theobturator 10 is provided with two annular grooves formed about itscircumference, a proximal groove 12a adjacent end 11 and a distal groove12b. The end of obturator 10 opposite to the rounded axial end 11 isprovided with a central axial threaded opening 15 leading to an innerlumen or chamber 14. A plurality of radial apertures 16 are in opencommunication with chamber 14. A tubular supportive pipe 13 isthreadably engaged within opening 15 and is used to permit externalpositioning and control of obturator 10 by the surgical assistant.

The holding obturator 20 is also provided with a smoothly rounded tip atone axial end 21 and an annular groove 22 about its circumference. Theremaining end of obturator 20 has a threaded opening 23 formed thereinto receive a supportive pipe 13 as described above.

The first form of perineal tractor is shown as an annular disc 37 (FIGS.7, 8) made of metal or other suitable material. It has a manuallyadjustable locking bolt 38 threadably received through a radial apertureto permit the user to lock disc 37 at any desired axial position alongpipe 13.

FIGS. 2-5 illustrate the general procedures by which the illustrativeobturators l0 and 20 are used during bowel surgery. The cleansingobturator 10 is used initially to isolate the lower bowel section andfacilitate cleansing. When operating on lower lesions, obturator 10 canbe inserted on a 10 cm. pipe l3'by use of a rectal speculum 18 or bypassing obturator 10 blindly with care from the perineum below with thehelp of the surgeons hand in the pelvis. For more proximal colonlesions, a 40 cm. pipe 13 would be used and inserted under visionthrough a proctoscope.

After insertion of obturator 10, the surgeon is able to bring the bowelinto apposition to obturator by application of a restrictive band 17about the bowel exterior within the axial confines of the proximalgroove 12a. Band 17 can be in the form of a penrose drain, a rubberband, a suture or suitable restrictive elements capable of apposing thebowel to the proximal groove 12a. Sterile water, or a saline, cleansingantiseptic, antibiotic, or other suitable solution is irrigated throughpipe 13 at an appropriate pressure level and for an appropriate lengthof time to achieve the cleansing results desired. The fluid is free topass out through the speculum 18. It is not advisable to apply suctionto pipe 13 at this point. Suction would aspirate cancer cells or faecesinto obturator 10. The washing action of the solution removes cancerouscells from the surface of obturator 10 and cleanses the interior ofbowel 8 distal to the point at which the bowel is apposed to theproximal groove 12a.

Following cleansing of bowel 8 through the use of holes or apertures 16,the bowel 8 is apposed at the distal groove 12b by a second ligature orother band 17, (FIG. 3). Pipe 13 can then be removed by releasing thethreaded connection between it and obturator 10. The bowel can again bewashed by introduction of fluid through the open end of pipe 13. Thesolution can be allowed to flow out the anal canal through rectalspeculum 18, or suction can be applied through the open end of pipe 13.The two stage procedure irrigation with bowel 8 apposed at proximalgroove 12a and subsequent irrigation with bowel 8 apposed at distalgroove l2bserves to decrease the seeding of shed cancer cells at thetime of surgical resection of bowel 8.

When an adequate length of bowel exists distally, a ligature or band ofheavy material (not shown) may be placed and tied distal to obturator 10prior to sectioning of the bowel. This would prevent contents withinobturator 10 from spilling back. However, this procedure is not feasiblein the case of low lesions. Where the bowel cannot be tied distal toobturator 10, a small glove or sleeve (not shown) may be placed over theobturator and bowel to prevent further spillage of cancer cells.

When operating to remove a low lying lesion, the surgeon requiresmaximum access to the lower portions of the bowel to completeanastomosis. To accomplish this, the obturator 20 is inserted into thebowel as shown in FIG. 4. This is accomplished prior to transection ofthe bowel 8. The bowel is apposed to the groove 22 of obturator 20 (FIG.4). In lower lesions, the obturator 10 and obturator 20 may be virtuallycontiguous, but sufficient length of colon should be free proximal toobturator 20 to allow anastomosis. After the bowel has been secured toboth obturators- 10, 20 as shown in FIG. 4, the mesentry and lymph nodesare excised by the surgeon in the usual manner.

One advantage of the use of obturator 20 is that it provides the surgeonwith an adequate and known length of bowel for resection. Furthermore,when operating in the restricted confines of the pelvic area,conventional procedures often are inadequate to insure surgicalresection in the lower reaches of the bowel. Inward pressure on theobturator 20, through the attached pipe 13, can assist the surgeon inreaching and surgically joining the severed sections of the bowel. Tosafely accomplish this, a tractor 37 should be used as shown in FIG. 7.Tractor 37 is mounted about pipe 13 at a location spaced axially outwardfrom obturator 20. It is adjustably fixed to pipe 13 by manipulation ofbolt 38. The surgeon or assistant is then able to move the obturator andtractor in unison to push inwardly and move the perineum inward alongwith the bowel. This greatly improves the internal access of the surgeonto the lower portions of the bowel without further stretching or risk ofdamage to the bowel. This inward movement can often result in providingthe surgeon with access to the bowel as necessary for successfulanastomo- SIS.

FIG. 5 illustrates the above structure in use. The obturator 20 has beeninserted up the anal canal. The judgement of the surgeon, based on thelevel of the lesion to be removed, dictates the level of obturator 20and the axial position of tractor 37 along the supportive pipe 13. Thestretched distance between obturator 20 and the perineal tractor 37,plus the inward or upward pressure of the assistant or supportive pipe13 brings the lower rectal segment closer to the surgeon for ease ofanastomosis.

The diagram shown in FIG. 6 illustrates intraabdominal traction, appliedthrough an intermediate or connecting obturator 30 and a second form oftractor 40. The details of these elements are illustrated in FIGS. 9 and10. Obturator 30 is axially threaded at both ends, having a tapered end31 to facilitate insertion. It is also provided with an intermediateannular groove 32 about its circumference. Its upper threaded opening isshown at 33 and lower threaded opening is shown at 34. It is designed tobe carried between a connecting rod 35 and a supportive rod 36, both ofwhich are threaded along their length to complement the threadedopenings 33, 34 respectively.

The obturator 30 can be utilized with only the supportive rod 36attached to it, in the manner described above with respect to obturator20. It is inserted anally with care and a suitable band 17 can be usedto appose bowel 8 to obturator 30.

The double-ended rod 35 permits attachment of a holding obturator 20inward of obturator 30 as shown in FIG. 6. The inner obturator 20provides the surgeon with a handle for internal manipulation or pullingto bring the apposed bowel and perineal area contacted by tractor 40into the pelvic recess where anastomosis must be accomplished.

The obturator 30 can also be inserted internally after severing of thebowel. A spare holding obturator 20 and intermediate or connectingobturator 30 would be used in combination with a connecting rod 35 andsupportive rod 36. The assembly would be passed into the lumen of thetransected rectal segment and out of the anal canal in an orientationopposite to that shown in FIG. 6. A surgical assistant would then removethe obturator 20 and replace it with a tractor 40. The bowel would thenbe apposed to obturator 30 and tractor 20 would be threadably adjustedalong the rod 35 to provide maximum stretch of the bowel betweenobturator 30 and tractor 40. The supportive rod 36, which protrudes intothe surgical area can then be used by the surgeon, with or without anobturator at its inner end, to exert a pull on the bowel to facilitateplacement of the posterior row of the anastomosis. The surgeon wouldthen remove the interior obturator and rod 36 from obturator 30. Theassistant can then exert a pushing force in the perineum area andelevate the operative area of the rectum by action of tractor 40 whilethe surgeon completes the anterior row of anastomosis. Finally, the band17 about obturator 30 must be removed and the obturator and connectingrod are then withdrawn anally by the assistant.

The above description sets out the general concepts of the structure andits usage in facilitating anastomosis. Modifications might be made withrespect to specific details while remaining within the intended scope ofthis disclosure.

Having thus described my invention, 1 claim:

1. A tool for use in lower colon surgery performed internally within apatient, comprising:

a cylindrical obturator having a first axial end smoothly rounded tofacilitate its insertion within the bowel;

an annular groove formed about the circumference of the cylindricalobturator, enabling the surgeon to bring the bowel into apposition tothe obturator by application of a restrictive band about the bowelexterior within the confines of the groove;

a rigid elongated member mounted coaxially to the remaining axial end ofthe obturator, whereby the location of the obturator within the bowelcan be controlled by manual manipulation of the elongated member;

and a radially protruding tractor mounted to the elongated member at alocation thereon spaced axially outward from said remaining axial end ofthe cylindrical obturator enabling the surgeon to move the obturator andtractor in unison to move the perineum inward and thereby improveinternal access of the surgeon to the lower portions of the bowel.

2. A tool as set out in claim 1 further comprising:

adjustable mounting means operatively connected between the elongatedmember and said tractor for permitting axial adjustment of the spacingbetween the tractor and said remaining axial end of the cylindricalobturator.

3. A tool as set out in claim 2 wherein the cylindrical obturator has aninner lumen with radial apertures formed through the cylindrical wallsof the obturator in communication with the inner lumen,

said rigid elongated member comprising a hollow tube in sealedcommunication with the inner lumen of said obturator;

the radial apertures being formed at the distal side of the annulargroove about the cylindrical obturator;

a second annular groove formed about the circumfer' ence of thecylindrical obturator at the distal side of said radial apertures.

4. A tool as set out in claim 1 further comprising: a second rigidelongated member selectively fixed coaxially to the smoothly rounded endof the obturator to enable the surgeon to manipulate the obturator andtractor from an internal location.

1. A tool for use in lower colon surgery performed internally within apatient, comprising: a cylindrical obturator having a first axial endsmoothly rounded to facilitate its insertion within the bowel; anannular groove formed about the circumference of the cylindricalobturator, enabling the surgeon to bring the bowel into apposition tothe obturator by application of a restrictive band about the bowelexterior within the confines of the groove; a rigid elongated membermounted coaxially to the remaining axial end of the obturator, wherebythe location of the obturator within the bowel can be controlled bymanual manipulation of the elongated member; and a radially protrudingtractor mounted to the elongated member at a location thereon spacedaxially outward from said remaining axial end of the cylindricalobturator enabling the surgeon tO move the obturator and tractor inunison to move the perineum inward and thereby improve internal accessof the surgeon to the lower portions of the bowel.
 2. A tool as set outin claim 1 further comprising: adjustable mounting means operativelyconnected between the elongated member and said tractor for permittingaxial adjustment of the spacing between the tractor and said remainingaxial end of the cylindrical obturator.
 3. A tool as set out in claim 2wherein the cylindrical obturator has an inner lumen with radialapertures formed through the cylindrical walls of the obturator incommunication with the inner lumen, said rigid elongated membercomprising a hollow tube in sealed communication with the inner lumen ofsaid obturator; the radial apertures being formed at the distal side ofthe annular groove about the cylindrical obturator; a second annulargroove formed about the circumference of the cylindrical obturator atthe distal side of said radial apertures.
 4. A tool as set out in claim1 further comprising: a second rigid elongated member selectively fixedcoaxially to the smoothly rounded end of the obturator to enable thesurgeon to manipulate the obturator and tractor from an internallocation.